Provider Demographics
NPI:1801094800
Name:POCONO PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:POCONO PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-688-2929
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SCOTRUN
Mailing Address - State:PA
Mailing Address - Zip Code:18355-0325
Mailing Address - Country:US
Mailing Address - Phone:570-688-2929
Mailing Address - Fax:570-688-0022
Practice Address - Street 1:408 SCOTRUN AVE
Practice Address - Street 2:
Practice Address - City:SCOTRUN
Practice Address - State:PA
Practice Address - Zip Code:18355-9663
Practice Address - Country:US
Practice Address - Phone:570-688-2929
Practice Address - Fax:570-688-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007511-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty